Metatarsalgia: Can Orthotics Help?

Metatarsalgia is a common foot problem and can be caused by a number of different things. The pain from metatarsalgia can be enough to ruin one’s day.

If you’re suffering from metatarsalgia, can orthotics help relieve your pain? They may be the best solution to treating ball-of-foot pain without the need for buying a new pair of shoes.

Let’s have a look at this foot condition and how to treat it.

What is metatarsalgia?

Metatarsalgia is the medical term for tenderness and pain in the ball of the foot.

It can be caused by a variety of factors, but they all have a common root cause—an overload on the transverse arch, causing it to collapse.

This change in the foot’s alignment places the metatarsal heads under pressure, which leads to inflammation and pain in the ball of the foot.

Common symptoms of metatarsalgia

Metatarsalgia usually develops over time, but it can also appear suddenly—especially if you’ve increased the time or intensity of physical activity.

You may experience a sharp, burning, or aching pain in the forefoot—under your foot just behind your toes. This is the most common symptom.

Some people may also experience numbness, tingling, or shooting pains in your toes. There may be bruising or inflammation in the ball of the foot.

Most often, the pain and other symptoms can be felt in the area around the second, third and fourth toes. Sometimes you may experience pain in the area close to the big toe.

When pressure is put on the foot—by walking, running, or standing—you may notice an increase in pain, or it may feel like you have a small pebble in your shoe.

There may be an increase in pain when you walk barefoot—especially if you’re walking on a hard surface—or when you flex your foot.

Check the soles of your feet, as you may develop calluses under the second, third, and fourth toes if you have metatarsalgia.

If you’ve been on your feet for most of the day, you may experience pain that goes away when you put your feet up and rest.

Common causes of metatarsalgia

Metatarsalgia is most often the result of an overuse injury, where body weight isn’t evenly distributed. This creates constant pressure on the metatarsal heads which leads to pain and inflammation in the forefoot.

While overuse is the most common reason for developing metatarsalgia, it’s not the only reason.

If you’re experiencing symptoms of metatarsalgia, it could also be caused by having a naturally high arch. Weight from people with high arches—especially if you’re not wearing shoes with adequate arch support—will be distributed to the forefoot. This places stress on the midfoot bones and metatarsal heads, which leads to pain and inflammation.

Women who wear high heels that have a small toe box and heels over three inches high will often develop metatarsalgia. The narrow toe box and heel height create constant pressure on the metatarsal heads.

Foot conditions such as bunions, hammer toes, claw toes, and osteoarthritis can lead to metatarsalgia. These conditions affect the bones and nerves in the foot.

Other causes of metatarsalgia are tight Achilles tendons, tight toe extensors, and weak toe flexors, which will affect the way in which the pressure and weight is distributed in the foot.

Wearing ill-fitting shoes or shoes that don’t provide adequate stability, shock absorption and support for your foot shape will increase your risk of developing metatarsalgia. Try to avoid exercise or do high-impact activities in worn shoes that no longer provide sufficient cushioning or support.

When walking or running, the force that is exerted on your feet can be up to three times your own body weight. If a person is overweight, this will place the midfoot bones under excessive pressure when moving around and increases the risk of developing metatarsalgia.

As we get older, the shape of our feet changes and the fat pad in the forefoot becomes thinner. The sensitive connective tissue and joints are then more exposed to pressure and strain, which leads to micro-tears and inflammation.

But, metatarsalgia isn’t always the result of physical activity.

An injury or stress fracture to the foot will cause one to change the way they walk. This changes how much pressure is placed on the foot bones, which can lead to inflammation.

Metatarsalgia treatment plan

Metatarsalgia can take weeks or months to heal. There are steps you can take to not only alleviate the symptoms but prevent it from coming back.

The first step is to rest your foot as much as you can. This may mean swapping your exercise routine for low-impact activities like cycling or swimming. When you do rest your foot make sure to elevate it, especially after you’ve been walking or standing.

Apply ice packs to the forefoot for 15 to 20 minutes several times a day. Be sure to wrap the ice packs in a thin towel and don’t leave the ice on the affected area for more than 20 minutes.

To help reduce the inflammation and alleviate the pain, you can take over-the-counter pain medication like Motrin IB, Ibuprofen, or Advil.

Change your shoes and make sure that the new shoes have a spacious toe box, cushioning, and adequate arch support for your foot shape. You may also want to try orthopedic shoes.

To prevent your foot from sliding forward in the shoe, make sure that heel height is 3 inches or less. This will prevent pressure from being placed on the metatarsal heads.

To provide support to the metatarsals, you should consider using metatarsal orthotics that are designed specifically to reduce the amount of stress placed on the forefoot.

What do orthotics do?

Metatarsal orthotics—also called inserts or insoles—have a built-in metatarsal pad. These pads fit behind the transverse arch and curve upwards towards the ball of the foot to provide arch support.

These inserts and insoles are often made from a thick foam—EVA or open-cell polyurethane foam— that reduces the impact to the foot.

Inserts and insoles will help to realign your foot and keep it in its natural alignment while distributing your body weight evenly.

This reduces the strain and pressure on the metatarsal bones and reduces the risk of injury to surrounding ligaments, tendons, and bones.

Insert options

Metatarsalgia insoles 3/4 length

These insoles extend from the heel to the ball of the foot and will feature a built-in metatarsal pad. The metatarsal pad supports the transverse arch, which helps to realign your foot and reduce the pressure on the forefoot.

It would be best to use these kinds of insoles if you have other foot conditions like bunions or hammer toes, as the design leaves space for your toes to splay naturally in the toe box.

People with narrow feet may find that they get a more comfortable fit by using ¾ length insoles.

Metatarsalgia insoles full-length

Full-length metatarsalgia insoles can feature either a built-in metatarsal dome or be raised to support the bones in the forefoot. One will be able to choose the type of arch support they need. The following support is provided:

  • Flexible
  • Semi-rigid
  • Rigid

This helps provide the arch with stability and prevents the arch of the foot from collapsing. The full-length insoles will also feature a deep heel cup that helps to keep your foot in its natural alignment as you move through your gait cycle.

Padding in the forefoot and the heel of the insole reduces the impact when walking or running. These insoles often work best when used in lace-up shoes or work boots.

Metatarsal shoe pad

Metatarsal pads—also called met pads—come in a variety of shapes, sizes, and thicknesses. These small pads are placed inside your shoe, just behind the ball of your foot—under the transverse arch—where they can support the metatarsal bones.

The shape of the met pads are designed to reduce the pressure on the forefoot by helping to realign the transverse arch so that your toes can splay naturally.

These are best used in shoes where the toe box is slightly narrower, or if you have a heel.

Knipe, Henry, and Geon Oh. “Transverse arch of the foot” Accessed August 8, 2021.